Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: In patients with rheumatoid arthritis (RA), ACR treatment guidelines recommend treating to targets based on quantitative endpoints, with modification of therapy as needed to achieve those targets. Integrated Healthcare Delivery Networks (IDNs) collect data in electronic health records (EHR), which can be used to assess quality of care, manage costs, and support treatment decisions. This study examined the availability of clinical measures across IDNs among patients with RA who received a biologic or a targeted synthetic disease-modifying antirheumatic drug (tsDMARD).
Methods: In this retrospective analysis of the Optum One EHR database, patients were 18 years or older, had RA diagnoses ≥7 days apart between June 30, 2008 and July 31, 2015. For patients who switched from a tumor necrosis factor inhibitor (TNFi) to a different medication, the index date was the switch date. Among other patients with a prescription for a biologic or tsDMARD, the index date was the first prescription written. Analysis periods were “baseline” (1 year pre-index), or “follow-up” (1 year post-index). EHR reporting rates were determined for quantitative measures to guide treatment decisions: clinical measurements (height, weight, blood pressure, cholesterol, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], or tuberculosis [TB] test) and validated disease severity instruments (Routine Assessment of Patient Index Data [RAPID3], Disease Activity Score [DAS28], or Clinical Disease Activity Index [CDAI]). Mean ESR and CRP in follow-up were summarized.
Results : The 29,829 patients were 76.8% female, 80.1% age ≥45 years, and 83.8% Caucasian. Baseline TB reporting rate in EHRs was 18.8%. EHR reporting rates in follow-up (median, 6 office visits) were: 49.0% ESR or CRP; and 6.5% ≥1 disease severity measure (5.8% RAPID3, 0.2% DAS28, 0.6% CDAI). Data reporting in EHRs varied significantly across the 10 largest IDNs, including a range of 0.0% to 25.2% for disease severity measure reporting in follow-up. Mean±SD values for ESR and CRP in follow-up were 13.9±8.0 mm/hr and 5.7±4.2 pcg/mL, respectively; variations in ESR and CRP values were less pronounced than variations in EHR reporting rates.
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Table. EHR reporting rates and reported ESR/CRP values, by IDN |
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Baseline |
Follow-up |
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≥1 TB |
≥1 ESR or |
ESR, mm/hr |
CRP, pcg/mL |
≥1 RAPID3, |
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|
n |
Mean±SD |
n |
Mean±SD |
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Total (N=29,829) |
18.8% |
49.0% |
7,750 |
13.9±8.0 |
9,303 |
5.7±4.2 |
6.5% |
|
IDN Rank 1 (N=4,116) |
22.0% |
52.9% |
1,068 |
13.2±8.1 |
1,470 |
5.1±4.2 |
25.2% |
|
IDN Rank 2 (N=3,307) |
19.3% |
55.4% |
1,059 |
14.5±7.5 |
946 |
5.1±4.5 |
1.8% |
|
IDN Rank 3 (N=2,963) |
13.6% |
41.0% |
693 |
15.1±7.6 |
839 |
5.8±4.1 |
0.0% |
|
IDN Rank 4 (N=2,787) |
22.7% |
38.5% |
632 |
13.1±8.3 |
501 |
6.0±3.7 |
3.5% |
|
IDN Rank 5 (N=2,143) |
9.1% |
43.9% |
550 |
14.6±8.0 |
634 |
5.4±4.1 |
0.3% |
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IDN Rank 6 (N=1,916) |
27.9% |
60.7% |
735 |
13.1±8.2 |
855 |
5.7±4.1 |
2.8% |
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IDN Rank 7 (N=1,566) |
14.7% |
23.4% |
231 |
14.2±8.1 |
186 |
5.8±4.5 |
0.0% |
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IDN Rank 8 (N=1,484) |
13.3% |
65.1% |
499 |
13.5±8.3 |
627 |
5.8±4.4 |
9.4% |
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IDN Rank 9 (N=1,065) |
44.6% |
70.4% |
92 |
11.2±7.8 |
624 |
5.2±4.3 |
0.1% |
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IDN Rank 10 (N=1,027) |
20.5% |
65.1% |
465 |
13.8±7.5 |
463 |
5.7±3.8 |
6.7% |
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Other IDN |
15.8% |
46.3% |
1,726 |
14.3±8.1 |
2,158 |
6.3±4.3 |
6.7% |
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p-value* |
<0.001 |
<0.001 |
<0.001 |
<0.001 |
<0.001 |
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*p-value for the comparison across individual IDNs by Chi-square test (for proportions) or ANOVA (for means). |
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Conclusion: In this analysis of EHR reporting of clinical data among RA patients in IDNs who switched from a TNFi or received a biologic or tsDMARD, approximately 1 in 5 had a TB test reported pre-index and half had ESR and/or CRP reported post-index. Validated measures of disease severity (RAPID3, DAS28, or CDAI) were reported infrequently, and EHR reporting was highly variable across IDNs. With greater emphasis on a treat-to-target approach, more consistent and more complete EHR reporting is recommended to assist rheumatologists in tracking whether treatment targets for RA are being met with biologic or tsDMARD therapy appropriately.
To cite this abstract in AMA style:
Chastek B, Chen CI, Kimura T, Fay J, Korrer S, Fiore S. Availability of Clinical Measures for Patients with Rheumatoid Arthritis in Integrated Delivery Networks Who Receive a Biologic or Targeted Synthetic Disease-Modifying Antirheumatic Drug: A Real-World Analysis of an Electronic Health Records Database [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/availability-of-clinical-measures-for-patients-with-rheumatoid-arthritis-in-integrated-delivery-networks-who-receive-a-biologic-or-targeted-synthetic-disease-modifying-antirheumatic-drug-a-real-world/. Accessed .« Back to ACR/ARHP Annual Meeting 2017
ACR Meeting Abstracts - https://acrabstracts.org/abstract/availability-of-clinical-measures-for-patients-with-rheumatoid-arthritis-in-integrated-delivery-networks-who-receive-a-biologic-or-targeted-synthetic-disease-modifying-antirheumatic-drug-a-real-world/